Antonio Salsano1,2, Jingda Liao3,4, Ambra Miette1,2, Massimo Capoccia5, Giovanni Mariscalco3,4, Francesco Santini1,2, Antonio F Corno6,7. 1. Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, L.go Rosanna Benzi, 10, 16143, Genoa, Italy. 2. Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy. 3. Cardiovascular Research Center, University of Leicester, Leicester, United Kingdom. 4. Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom. 5. Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. 6. Houston Children Heart Institute, Hermann Children's Hospital, Houston, Texas, United States of America. 7. University Texas Health, McGovern Medical School, Houston, Texas, United States of America.
Abstract
BACKGROUND: Kawasaki disease (KD) is a systemic inflammatory condition occurring predominantly in children. Coronary artery bypass grafting (CABG) is performed in the presence of inflammation and aneurysms of the coronary arteries. The objectives of our study were to assess which CABG strategy provides better graft patency and early and long-term outcomes. METHODS: A systematic review using Medline, Cochrane, and Scopus databases was performed in February 2020, incorporating a network meta-analysis, performed by random-effect model within a Bayesian framework, and pooled prevalence of adverse outcomes. Hazard ratios (HR) and corresponding 95% credible intervals (CI) were calculated by Markov chain Monte Carlo methods. RESULTS: Among 581 published reports, 32 studies were selected, including 1,191 patients undergoing CABG for KD. Graft patency of internal thoracic arteries (ITAs), saphenous veins (SV), and other arteries (gastroepiploic artery and radial artery) was compared. ITAs demonstrated the best patency rates at long-term follow-up (HR 0.33, 95% CI: 0.17-0.66). Pooled prevalence of early mortality after CABG was 0.28% (95% CI: 0.00-0.73%, I 2 = 0%, tau2 = 0), with 63/1,108 and 56/1,108 patients, undergoing interventional procedures and surgical re-interventions during follow-up, respectively. Pooled prevalence was 3.97% (95% CI: 1.91-6.02%, I 2 = 60%, tau2 = 0.0008) for interventional procedures and 3.47% (95% CI: 2.26-4.68%, I 2 = 5%, tau2 <0.0001) for surgical re-interventions. Patients treated with arterial, venous, and mixed (arterial plus second venous graft) CABG were compared to assess long-term mortality. Mixed CABG (HR 0.03, 95% CI: 0.00-0.30) and arterial CABG (HR 0.13, 95% CI: 0.00-1.78) showed reduced long-term mortality compared with venous CABG. CONCLUSIONS: CABG in KD is a safe procedure. The use of arterial conduits provides better patency rates and lower mortality at long-term follow-up.
BACKGROUND: Kawasaki disease (KD) is a systemic inflammatory condition occurring predominantly in children. Coronary artery bypass grafting (CABG) is performed in the presence of inflammation and aneurysms of the coronary arteries. The objectives of our study were to assess which CABG strategy provides better graft patency and early and long-term outcomes. METHODS: A systematic review using Medline, Cochrane, and Scopus databases was performed in February 2020, incorporating a network meta-analysis, performed by random-effect model within a Bayesian framework, and pooled prevalence of adverse outcomes. Hazard ratios (HR) and corresponding 95% credible intervals (CI) were calculated by Markov chain Monte Carlo methods. RESULTS: Among 581 published reports, 32 studies were selected, including 1,191 patients undergoing CABG for KD. Graft patency of internal thoracic arteries (ITAs), saphenous veins (SV), and other arteries (gastroepiploic artery and radial artery) was compared. ITAs demonstrated the best patency rates at long-term follow-up (HR 0.33, 95% CI: 0.17-0.66). Pooled prevalence of early mortality after CABG was 0.28% (95% CI: 0.00-0.73%, I 2 = 0%, tau2 = 0), with 63/1,108 and 56/1,108 patients, undergoing interventional procedures and surgical re-interventions during follow-up, respectively. Pooled prevalence was 3.97% (95% CI: 1.91-6.02%, I 2 = 60%, tau2 = 0.0008) for interventional procedures and 3.47% (95% CI: 2.26-4.68%, I 2 = 5%, tau2 <0.0001) for surgical re-interventions. Patients treated with arterial, venous, and mixed (arterial plus second venous graft) CABG were compared to assess long-term mortality. Mixed CABG (HR 0.03, 95% CI: 0.00-0.30) and arterial CABG (HR 0.13, 95% CI: 0.00-1.78) showed reduced long-term mortality compared with venous CABG. CONCLUSIONS: CABG in KD is a safe procedure. The use of arterial conduits provides better patency rates and lower mortality at long-term follow-up.
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